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Opioid withdrawal with antagonists under heavy sedation to retain patients and reduce use
Summary of the evidence
Opioid withdrawal with antagonists under heavy sedation or anaesthesia was compared to withdrawal managed with reducing doses of methadone in a systematic review (Gowing 2010, 8 RCTs, N=1109) ) and no difference was found:
- in heroin use after 6 months (RR 0.97, 95 % CI 0.88 to 1.08);
- rates of retention in treatment at 12 months (RR 0.95, 95 % CI 0.69 to 1.30).
The overall authors' conclusion is that there is a significantly increased risk of serious adverse events with anaesthesia-assisted approaches. The lack of additional benefit, and increased risk of harm, suggest that this form of treatment should not be pursued.
